Department of Health & Human Services

Oklahoma did not follow its policies and procedures to ensure there was evidence in Title IV-E case files to support that all required health care services were provided to Title IV-E children in foster care. Nor were there Medicaid claims in the State's Medicaid Management Information System to...

Texas did not always make increased Medicaid payments to providers and claim reimbursement in accordance with Federal requirements. Of the $721 million in Federal funds that it received, Texas inappropriately received $20.7 million because (1) it incorrectly claimed the 100-percent matching rate for...

The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) applied to both the Children’s Health Insurance Program and Medicaid. Under CHIPRA, Congress appropriated $3.2 billion for qualifying States to receive bonus payments to offset the costs of increased enrollment of children...

The Colorado Department of Health Care Policy and Financing (State agency) claimed Federal Medicaid reimbursement for some Targeted Case Management (TCM) services that did not comply with Federal and State requirements for fiscal years (FYs) 2014 and 2015. Of the 150 randomly sampled TCM claims we...

Medicare paid a total of $17.6 million in telehealth payments in 2015, compared with $61,302 in 2001. Medicare telehealth payments include a professional fee, paid to the practitioner performing the service at a distant site, and an originating-site fee, paid to the facility where the beneficiary...

Provider-preventable conditions (PPCs) are certain reasonably-preventable conditions caused by medical accidents or errors in a health care setting. PPCs include two categories of conditions: health-care-acquired conditions (HCACs) and Other PPCs.

Sixty-one percent of Medicare claims for outpatient physical therapy services that we reviewed did not comply with Medicare medical necessity, coding, or documentation requirements. Specifically, of the 300 claims in our stratified random sample, therapists claimed $12,741 in Medicare reimbursement...

Although Washington State performed the required onsite monitoring at all 20 of the group care facilities that we reviewed, this monitoring did not ensure that these facilities complied with State licensing requirements related to the health and safety of children in foster care, as required by...

The President's Emergency Plan for AIDS Relief (PEPFAR) was authorized to receive $48 billion in funding for the 5-year period beginning October 1, 2008, to assist foreign countries in combating HIV/AIDS, tuberculosis, and malaria. Additional funds were authorized to be appropriated through 2018.

Children's partial hospitalization is an outpatient treatment program provided in a hospital-based setting for youth and young adults and intended to minimize the need for inpatient hospitalization. A prior review of New Jersey's claims for Medicaid adult partial hospitalization services identified...